Near-miss events, where no actual harm comes to the patient, represent a low-risk opportunity to improve patient safety and address patient expectations about medical care risks, both factors associated with medical malpractice suits and awards. The Institute of Medicine (IOM) has called for the creation of voluntary reporting systems to detect near-miss events that occur in individual health care organizations, and to allow for analysis of patterns of errors that may affect many or all providers of care. To date, most attempts to record and address near-miss events in the United States have been conducted in hospitals. More extensive system development and evaluation are needed to effectively extend near-miss reporting to non-hospital settings. This planning grant will initiate a study that will be among the first to present and evaluate a near-miss reporting system in a broad range of primary care settings. The primary goal is to better understand the barriers, facilitators, and results of implementing a near-miss reporting and improvement tracking system in primary care. The secondary goal is to explore the potential of using near-miss events to increase provider confidence and experience with error disclosure to patients, and whether such disclosure decreases the likelihood that patients will seek legal advice and file malpractice claims in the event of a harmful medical event. The North Carolina Office of Rural Health and Community Care (ORHCC) proposes to conduct a preliminary study of a near-miss reporting and improvement tracking system. The near-miss reporting and tracking system will be introduced into six diverse practices participating in a regional ambulatory practice network. The intervention has three components: 1) a standardized orientation for each practice;2) reporting and collection of near-miss reports from each practice for six months, and 3) ongoing educational and quality improvement efforts aimed at understanding and learning from the near-miss events including ongoing staff prompts and reminders to use the system. Research aspects of the study include: a) evaluation of the implementation of the system in the six study practices;b) analysis of the types of near-miss events reported including their correlates and the validity of seriousness ratings;and c) evaluation of patient and provider reported behaviors regarding the influence of near-miss disclosure. As a result of this preliminary study, the research team expects to gain a better understanding about how to implement a near-miss reporting system in primary care settings, how practices respond to near-miss event reporting (e.g., which types of events may be most amenable to improvement), how increased recognition of near-miss events relates to provider awareness and attitudes toward patient safety and practice change, and how provider disclosure might influence patient behavior in terms of seeking legal advice. PUBLIC HEALTH RELEVANCE: Rising malpractice and health care costs make efforts to improve patient safety in the primary care setting both timely and important. Near-miss events, which have the potential to lead to patient harm but harm is averted, represent a significant opportunity to correct flaws that create risks to patient safety, yet few near-miss reporting systems exist outside of hospital settings. Through implementation and evaluation of a near-miss reporting and remediation tracking system in six primary care practices, this preliminary study will lead to better understanding of how practices respond to near-miss reporting (e.g., which types of events may be most amenable to improvement), how increased recognition of near-miss events relates to provider attitudes toward patient safety and practice change, and how provider disclosure of near-misses might influence patient behavior in terms of seeking legal advice.